A Multidisciplinary Team Approach Improves Door to Groin Puncture Time for Endovascular Stroke Therapy in a Comprehensive Stroke Center

Objective: To evaluate the policies and procedures to improve the Door to Groin Puncture (Door-to-Groin) time. We hypothesize that by segmenting the process into three phases: (1) Door to Computed Tomography Angiography performed (Door-to-CTA), (2) CTA performed to Interventional Radiology (IR) suite arrival (CTA-to-IR), and (3) IR arrival to Groin Puncture (IR-to-Groin), will enable the Door-to-Groin goal to be achieved under 70 minutes. Background: Tertiary hospitals are reorganizing to provide more efficient and rapid access to endovascular stroke care. Endovascular interventions are time-sensitive and must be initiated immediately. Process map analysis illustrated that delays in Door-to-Groin time were not due to one specific cause. As guidelines changed, we developed a multidisciplinary collaborative process to encourage departments to avoid working in silos. Design/Methods: A prospective data collection was performed between January 2015 to April 2017 (n=68 patients). The multidisciplinary team discussed endovascular intervention times for every patient. Policies streamlining procedure setup, rapid documentation and patient preparation were introduced to all staff. The intervention involved a parallel process approach that resulted in significant time saving. Descriptive statistics were performed. Results: The Door-to-Groin time decreased by 56% from the first quarter of 2015 (156 minutes, n=3) to the first quarter of 2017 (68.4 minutes, n=18). The average Door-to-Groin time progressively decreased with time [2015 (127 minutes, n=20); 2016 (87.9 minutes, n=30); first quarter of 2017 (68.4 minutes, n=18)]. The streamlined processes aimed at reducing the Door-to-CTA, CTA-to-IR, and IR-to-Groin times, collectively reduced the Door-to-Groin time, thereby, reducing revascularization time. Identifying gaps in communication and performance had a positive impact on patient health outcomes and employee engagement. Conclusions: Complex processes, involving multiple stakeholders, can be streamlined when a targeted improvement process is employed. Utilizing evidence-based medicine to identify appropriate communication and performance gaps yields a reduction in preparation time and directly influences revascularization times. Disclosure: Dr. Wright has nothing to disclose. Dr. Katz has nothing to disclose. Dr. Wright has nothing to disclose. Dr. Setton has nothing to disclose. Dr. Thirunavukkarasu has nothing to disclose.